Nanaimo Unique Kids Survey

Attention Deficit Disorders (ADD)

Attention-Deficit/Hyperactivity Disorder (ADHD) is a condition that can make it hard for a person to sit still, control behavior and pay attention. These difficulties usually begin before the person is 7 years old. However, these behaviors may be noticed earlier or may not be noticed until the child is older.

Doctors do not know just what causes ADHD. However, researchers who study the brain are coming closer to understanding what may cause ADHD. They believe that some people with ADHD do not have enough of certain chemicals (called neurotransmitters) in their brain. These chemicals help the brain control behavior.

As many as 5 out of every 100 children in school may have ADHD. Boys are three times more likely than girls to have ADHD.

There are three main signs, or symptoms, of ADHD. These are:

• problems with paying attention,

• being very active (called hyperactivity), and

• acting before thinking (called impulsivity).

Based on these symptoms, three types of ADHD have been found:

• inattentive type, where the person can’t seem to get focused or stay focused on a task or activity;

• hyperactive-impulsive type, where the person is very active and often acts without thinking; and

• combined type, where the person is inattentive, impulsive, and too active.

• When a child shows signs of ADHD, he or she needs to be evaluated by a trained professional. A complete evaluation is the only way to know for sure if the child has ADHD. Top of Page

Autism Spectrum Disorders(ASD) and Pervasive Developmental Disorders (PDD)

Internationally, the most widely used definition of autism is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Although autism was first included in the third edition of the DSM in 1980, it was the fourth edition of the DSM (DSM-IV-TR), released in 2000, that placed “Autistic Disorder” in a group of five “Pervasive Development Disorders” (PDD) that also comprises “Rett’s Syndrome,” “Childhood Disintegrative Disorder,” “Asperger’s Syndrome,” and “Pervasive Development Disorder Not Otherwise Specified (PDDNOS).”

Autism Spectrum Disorders (ASDs) (also referred to as PDDs) are brain-based developmental disabilities that affect a child’s ability to communicate, understand language, play and relate to others. The ASDs affect an estimated 1 in 150 births (Centers for Disease Control and Prevention, 2005). This means that as many as 1.5 million Americans today are believed to have an autism spectrum disorder. Autism is typically diagnosed by three years of age; however, researchers here at CARD are currently working to detect the signs and symptoms of autism at the earliest age possible. By detecting autism at a young age, children can gain earlier access to intervention services.

A diagnosis of autism is made when an individual displays at least 6 of 12 symptoms distributed across three major areas:

• social interaction,

• communication, and

• repetitive/stereotyped patterns of behavior and interest.

Specifically, an individual with autism may have difficulty with social behaviors such as eye contact, the use of spoken words, may use gestures to enhance verbal communication, may use repetitve and steroetypical behaviors such as flapping the hands or persistently repeating words or phrases. Individuals with Aspergers syndrome display a slightly different behavior pattern than that of individuals with autism. These individuals have difficulties with social interaction, understanding social conventions, social use of language (e.g., they may be overly talkative, be overly focused on topics of their special interest, fail to give important background information because they have problems judging their listener’s informational needs, and so on), and may exhibit the repetitive behaviors, unusual and intense interests, and be resistant to change. They acquire their language milestones on time, and have normal to superior cognitive abilities.

Children who do not meet the full criteria for autism or Asperger syndrome may receive a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). Children with autism, Asperger syndrome and PDD-NOS vary widely in abilities, intellectual functioning, and behaviors/interests. Therefore, it is important to focus on the individual child's behavioral and learning profile when making intervention decisions and recommendations. Top of Page

BehavioralDisorders/Self-injurious Behavior

Self-injurious behavior (SIB), displayed by individuals with autism and mental retardation, involves the occurrence of behavior that results in physical injury to one’s own body. Common forms of SIB include, but are not limited to head-hitting, head-banging, and hand-biting. In the most severe cases, SIB can result in retinal detachment, blindness, broken bones, bleeding, or death. SIB is displayed by 10% to 15% of individuals with autism and mental retardation. These estimates are higher among individuals living in institutions and among those with greater cognitive impairments. SIB is also associated with certain genetic disorders, such as Lesch-Nyhan and Rett Syndromes.

Individuals may engage in SIB for a variety of reasons. In some cases, SIB may occur because it results in favorable outcomes, such as attention from caregivers or the termination of academic or instructional demands. SIB may also be biologically based. For example, some research has suggested that SIB may result in the release of chemicals in the brain that produce pleasurable effects. Although there is considerable evidence to support of all of these explanations, current thought indicates that SIB is a highly complex, heterogeneous phenomenon that is often attributable to a combination of factors. Top of Page

Brain Injury (BI) (Includes Shaken Baby Syndrome, Accidents, Falls)

Brain Injury means an acquired injury to the brain that results in partial or total impairment in one or more areas of function. These areas of function include, but are not limited to, cognition; memory; attention; reasoning; abstract thinking; judgment; problem solving; information processing; speech and language; psychosocial behavior; sensory, perceptual, and motor abilities and physical functioning. A brain injury may be caused by any external or internal mechanism of injury, can vary in severity from mild to severe, and may result in short-term or long-term functional impairment. Acquired brain injuries may be associated with trauma, illnesses, anoxia, toxic exposures, or surgical interventions. The term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma. Top of Page

Cerebral Palsy (CP)

Cerebral palsy, often referred to as CP for short, is a condition that results from injury to the brain. The injury may occur before, during or shortly following birth. The word cerebral refers to the brain and palsy to difficulty in control of movement . Cerebral palsy is neither progressive nor communicable. Although it is not curable, medical and therapy intervention can help.

Depending on which part of the brain has been injured, different areas of the body will be involved or affected. The symptoms can vary greatly. For instance one or more of the following areas can be involved: general movement, walking, vision, hearing, speech, or learning. Top of Page

Communication/Speech/Language Disorders

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate and vocal abuse or misuse.

More than one million of the students served in the public schools’ special education programs in the 1998-99 school year were categorized as having a speech or language impairment. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness. Language disorders may be related to other disabilities such as mental retardation, autism, or cerebral palsy. It is estimated that communication disorders affect one of every 10 people in the United States.

A child's communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Speech disorders refer to difficulties producing speech sounds or problems with voice quality. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. Top of Page

Developmental Disability

The term "Developmental Disability" means a severe, chronic disability of an individual that:

1. is attributable to a mental or physical impairment or combination of mental and physical impairment;

2. is manifested before the individual attains the age of 22;

3. is likely to continue indefinitely;

4. results in substantial functional limitations in 3 or more of the following areas of major life activity:

• self-care

• receptive and expressive language

• learning

• mobility

• self-direction

• capacity for independent living

• economic self-sufficiency; and,

5. reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, individualized support, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated.

As defined by the Developmental Disabilities Assistance and Bill of Rights Act of 2000, Public Law 106-402.

Developmental Delay

Developmental delay is defined as failure to meet expected developmental milestones in one or more of the following areas: physical, social, emotional, intellectual, speech and language and/or adaptive development (sometimes called self-help skills, which include dressing, toileting, feeding, etc).

It is diagnosed when a child performs approximately 25 to 30% below age norms in one or more of these areas (with adjustment for prematurity in affected children). Progress occurs at a slower than expected rate following the anticipated sequence. Various medical and environmental causes exist.

Some examples of physical or mental disorders likely to result in delayed developmental are: chromosomal abnormalities; genetic or congenital disorders; severe sensory impairments, including hearing and vision; inborn errors of metabolism; disorders reflecting disturbance of the development of the nervous system; congenital infections; and disorders secondary to exposure to toxic substances, including fetal alcohol syndrome.

The verification of delay is obtained through an evaluation process which includes at least three of the following: informed clinical opinion to include observational assessment, standardized development test(s), developmental inventory, behavioral checklist, adaptive behavior measure, and parent interview. Developmental delay can occur temporarily or it can be long-term and never fully resolve. Top of Page

Down Syndrome

Down syndrome is the most common and readily identifiable chromosomal condition associated with mental retardation. Down syndrome is a genetic disorder that occurs in approximately 1 in 800 live births. It is caused most often by an abnormality during cell division in gamete formation called nondysjunction. As a result, the fertilized egg will contain three copies of chromosome 21. The extra chromosome interferes with normal growth and development. Therefore, it is important for parents, health care professionals, and teachers to have a clear and accurate understanding of each child’s medical concerns and level of developmental functioning. In most cases, the diagnosis of Down syndrome is made according to results from a chromosome test administered shortly after birth. Although parents of any age may have a child with Down syndrome, the incidence is higher for women over 35.

There are over 50 clinical signs of Down syndrome, but it is rare to find all or even most of them in one person. Some common characteristics include:

• Poor muscle tone;

• Slanting eyes with folds of skin at the inner corners (called epicanthal folds);

• Hyperflexibility (excessive ability to extend the joints);

• Short, broad hands with a single crease across the palm on one or both hands;

• Broad feet with short toes;

• Flat bridge of the nose;

• Short, low-set ears;

• Short neck;

• Small head;

• Small oral cavity; and/or

• Short, high-pitched cries in infancy.

Individuals with Down syndrome are usually smaller than their non-disabled peers, and their physical as well as intellectual development is slower. Besides having a distinct physical appearance, children with Down syndrome frequently have specific health-related problems. Top of Page

Epilepsy (Seizure Disorder)

According to the Epilepsy Foundation of America, epilepsy is a physical condition that occurs when there is a sudden, brief change in how the brain works. When brain cells are not working properly, a person's consciousness, movement or actions may be altered for a short time. These physical changes are called epileptic seizures. Epilepsy is therefore sometimes called a seizure disorder.

Some people can experience a seizure and not have epilepsy. For example, many young children have convulsions from fevers. These febrile convulsions are one type of seizure. Other types of seizures not classified as epilepsy include those caused by an imbalance of body fluids or chemicals or by alcohol or drug withdrawal. A single seizure does not mean that the person has epilepsy. About two million Americans have epilepsy; of the 125,000 new cases that develop each year, up to 50 percent are in children and adolescents.

Although the symptoms listed below are not necessarily indicators of epilepsy, it is wise to consult a doctor if you or a member of your family experiences one or more of them:

• "Blackouts" or periods of confused memory;

• Episodes of staring or unexplained periods of unresponsiveness;

• Involuntary movement of arms and legs;

• "Fainting spells" with incontinence or followed by excessive fatigue;

• Odd sounds, distorted perceptions, episodic feelings of fear that cannot be explained.

Seizures can be generalized, meaning that all brain cells are involved. Seizures are partial when those brain cells not working properly are limited to one part of the brain. Top of Page

Fetal Alcohol Syndrome(FAS)and Related Disorders

Fetal alcohol syndrome (FAS) is the leading known preventable cause of non-inherited mental retardation and birth defects, and is the most extreme case of prenatal alcohol exposure. It is diagnosed by the presence of facial abnormalities (small palprebral fissures, flattened filtrum and thin upper lip), growth deficiency (reduced head circumference, height and weight deficiency), central nervous system dysfunction (cognitive and neurobehavioral problems), and a confirmed history of prenatal alcohol exposure.

Blood vessels in the placenta provide nourishment and oxygen from a mother's body to her developing infant. When she drinks alcohol , it enters both the blood streams of her own body and that of her unborn child's body. A spectrum of neurobehavioral, cognitive and physical abnormalities can therefore exist, even in the absence of the criteria necessary for a diagnosis of FAS. These disabilities can be as devastating to the functioning of these individuals and their families as FAS, even without the mental retardation, growth deficits or dysmorphic facial features.

All women of child bearing age should understand that there is, at this time, no known minimum amount of alcohol that can be consumed safely during pregnancy. Alcohol therefore should never be consumed if the women expects to become pregnant or is already pregnant. Prenatal alcohol related disability is one of the most preventable causes of cognitive and neurobehavioral disability. Top of Page

Fragile X Syndrome

Fragile X syndrome is a hereditary condition which causes a wide range of mental impairment, from mild learning disabilities to severe mental retardation. It is the most common cause of genetically-inherited mental impairment. In addition to mental impairment, fragile X syndrome is associated with a number of physical and behavioral characteristics.

There are several tests that can be done to determine if someone has fragile X syndrome and if family members have the potential to transmit the gene for fragile X syndrome.

The biological cause of fragile X and the pattern of transmission of the disease are complex. Fragile X syndrome affects individuals in a wide variety of ways. Some individuals experience significant challenges because of the effects of fragile X, while the impact on others is so minor that they will never be diagnosed.

Males and females exhibit quite different physical, cognitive, behavioral, sensory, speech and language impacts of fragile X syndrome. In general, females with fragile X either do not have the characteristics seen in males, or the characteristics show up in a milder form. The difference is probably due to the fact that females have two x-chromosomes instead of the one that males carry. As a result, females who have fragile X, have two sets of instructions for making FMRP (fragile X mental retardation protein), one that works and one that doesn't. Top of Page

Learning Disorders (LD)

The regulations for Public Law 101-476, the Individuals with Disabilities Education Act (IDEA), define a learning disability as a "disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or to do mathematical calculations."

The Federal definition further states that learning disabilities include "such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia." The label "learning disabilities" describes a syndrome, not a specific child with specific problems. The definition assists in classifying children, not teaching them. Children with learning disabilities may exhibit a combination of characteristics.

Many different estimates of the number of children with learning disabilities have appeared in the literature (ranging from 1% to 30% of the general population). The U.S. Department of Education (2000) reported that, in the 1998-99 school year, over 2.8 million children with learning disabilities received special education and related services.

Students who have learning disabilities may exhibit a wide range of traits, including problems with reading comprehension, spoken language, writing or reasoning ability. Hyperactivity, inattention and perceptual coordination problems may also be associated with learning disabilities. Other traits that may be present include a variety of symptoms, such as uneven and unpredictable test performance, perceptual impairments, motor disorders, and behaviors such as impulsiveness, low tolerance for frustration, and problems in handling day-to-day social interactions and situations. Top of Page

Neurological Disorders

Neurology refers to the diagnosis and treatment of diseases and disorders of the nervous system including the brain, spinal cord, nerves and muscles. Neurological disorders are common and run the gamut from relatively innocuous problems like tension headaches to serious and debilitating problems like brain tumors, sleep disorders, strokes, serious seizures disorders, severe mental retardation, spinal cord paralysis and muscular dystrophy. The vast majority of disorders treated at KKI involve the nervous system and are neurological. However, since their manifestations and treatments are so diverse, neurological disorders have been divided into numerous sub-groups with their own specialized teams of physicians and therapists. Examples are epilepsy neurologists and neurogenetic neurologists who specialize in seizures and genetic disorders respectively, physiatrists who specialize in rehabilitation and neurodevelopmental pediatricians who care for children with learning and developmental problems. Top of Page

Psychiatric Disorders

In DSM-IV a mental disorder is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability, or with significantly increased risk of suffering death, pain, disability or an important loss of freedom.

Examples, Subsets and Synonyms for Psychiatric Disorders

• Adjustment Disorders

• Anxiety Disorders

• Panic Disorder - Obsessive/Compulsive Disorders, Post-Traumatic Stress Disorder, Phobias

• Impulse Control Disorder

• Mood Disorders

• Oppositional-Defiant Disorder

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Rett Syndrome

Rett Syndrome (RS) is a neurological disorder often misdiagnosed as autism, cerebral palsy or non-specified developmental delay caused by a defective regulatory MECP2 gene, found on the X chromosome seen almost exclusively in females. Unlike females, who have two X-chromosomes, males have an X and a Y chromosome. Because males lack a "backup" copy of the X chromosome that can compensate for a defective one, mutations in MECP2 are lethal to the male fetus. This is why RS is found overwhelmingly in females. Rett Syndrome occurs in a variety of racial and ethnic groups worldwide now known to occur from 1:10,000 to 1:23,000 female births, but incidence may be far greater as new genetic evidence is discovered.

Development appears normal until 6-18 months of age followed by loss of acquired speech and hand skills, slowing of head growth and development of stereotyped repetitive hand movements, loss or difficulty with mobility hand movements include handwashing, hand wringing, hand tapping, hand clapping and hand mouthing. Stereotyped hand movements may change over time and additional problems may include seizures, breathing irregularities (hyperventilation and apnea), teeth grinding and curvature of the spine (scoliosis). 99.5 % of cases of RS occur only once in a family. Barring illness or complications, survival into adulthood is expected. Top of Page